Request for Appeal to the California Unemployment Insurance Appeal Board 

Sent by Mail or Fax to (916) 263-6765 

California Unemployment Insurance Appeal Board 
Sacramento Office of Appeals 
2400 Venture Oaks Way 
Suite 100 
Sacramento, CA 95833 
(916) 263-6765 

Re: Board Appeal for Case No(s).  

Dear California Unemployment Insurance Appeal Board: 

I am writing to request a board appeal of the above decision(s). 

  1. Information for Processing Appeal 

Here is my information for processing the appeal: 

Claimant Name:  
Address:  
Phone Number:  
Email Address:  
Date of Decisions:  

  1. Request for Copy of Administrative Record 

As part of this appeal, I request a complete copy of the record in this matter, including a recording of the administrative hearing. It is my understanding that copies of the record are free to claimants. 

I am also requesting the opportunity to submit additional written argument after the receipt of the full administrative record. 

  1. Submission of Additional Evidence 

I am requesting that the following evidence be considered on appeal. 

  1. [Describe evidence.] This evidence is important because it shows [describe why important]. This evidence was not provided earlier because [explain why it was not provided earlier]. 
  1. [Describe evidence.] This evidence is important because it shows [describe why important]. This evidence was not provided earlier because [explain why it was not provided earlier]. 
  1. Argument 

I believe the Administrative Law Judge made the following errors in reaching the appealed decisions: 

  1. [argument] 
  1. [argument] 
  1. Acceptance of Untimely Appeal 

I request that the Appeal Board process and review my appeal. I have good cause for the delay because [explain the good reason why you had a delay in sending in the appeal]. 

  1. Conclusion 

Thank you for processing this appeal.  

Sincerely,